E. Jennifer Edelman and Kirsha Gordon contributed equally in the design and preparation of this manuscript.
Acetaminophen receipt among HIV-infected patients with advanced hepatic fibrosis†
Version of Record online: 22 SEP 2013
Copyright © 2013 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 22, Issue 12, pages 1352–1356, December 2013
How to Cite
Edelman, E. J., Gordon, K. S., Re, V. L., Skanderson, M., Fiellin, D. A., Justice, A. C. and for the VACS Project Team (2013), Acetaminophen receipt among HIV-infected patients with advanced hepatic fibrosis. Pharmacoepidem. Drug Safe., 22: 1352–1356. doi: 10.1002/pds.3517
This work was presented in an earlier version at the Veterans Aging Cohort Study Scientific Meeting, 13 October 2011, Washington, DC, and the Society of General Internal Medicine Annual Meeting, 26 April 2013, Denver, CO.
- Issue online: 28 NOV 2013
- Version of Record online: 22 SEP 2013
- Manuscript Accepted: 13 AUG 2013
- Manuscript Revised: 12 AUG 2013
- Manuscript Received: 28 MAR 2013
- hepatitis C;
HIV-infected patients may be at particular risk for acetaminophen-induced hepatotoxicity, but acetaminophen use in the context of liver injury has been incompletely examined among HIV-infected patients. Among a sample of HIV-infected patients, we aimed to determine acetaminophen exposure, assess the cross-sectional association between acetaminophen exposure and advanced hepatic fibrosis, and determine whether factors associated with acetaminophen exposure varied by HCV status.
We conducted a cross-sectional analysis of the Veterans Aging Cohort Study. Advanced hepatic fibrosis was defined as a FIB-4 > 3.25, a composite score calculated based on age, alanine aminotransferase, aspartate aminotransferase, and platelet count. Multivariable ordered polytomous logistic regression was used to determine the association between FIB-4 status and acetaminophen exposure stratified by HCV status.
Among HIV-infected patients (n = 14 885), 31% received at least one acetaminophen prescription. Among those receiving acetaminophen, acetaminophen overuse was common among both HIV-monoinfected and HIV/HCV-coinfected patients (846 [31%] vs 596[32%], p = 0.79). After stratifying by HCV status, those with evidence of advanced liver fibrosis were equally likely to be exposed to acetaminophen. Furthermore, HIV-monoinfected patients with an alcohol use disorder were more likely to have acetaminophen overuse (OR [95%CI] = 1.56 [1.21–2.02]).
Strategies to minimize acetaminophen exposure, especially for HIV-monoinfected patients, are warranted. Copyright © 2013 John Wiley & Sons, Ltd.